Medical Biller (OB/GYN)

Resume & Cover Letter required at time of application

POSITION SUMMARY :

The Medical Biller serves as the department expert in regards to all billing that is processed for the assigned area. The Medical Biller resolves unsettled items and assists in the recovery of underpayments and denials relative to patients’ accounts and third party payers. Works with billing staff to ensure informational data is accurate and timely, optimizing revenue and maximum cash flow benefit to the clinics. Duties also may include: ensuring charge entry and coding is correct, verifying insurance coverage, managing Workques of charges, edits and follow up in Epic. Manages consent forms for services billed to Masshealth.

Position: Medical Biller

Department: OB-GYN Administration

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Responds to billing company requests for additional information; includes correcting missing/invalid modifiers, diagnosis codes, or other elements to enable submission of billing to payers through Epic Workques.
• Performs follow-up with insurance companies, workers compensation payers, other third party payers, medical groups, outside hospitals, and physician’s offices to ensure timely payments of patient bills in accordance with the terms and conditions of each contract and/or insurance company policies.
• Researches and documents any questionable item causing the denial or underpayment of claims and makes efforts to appeal, re-bill or seek solutions for future improvements.
• Reviews denials in detail to determine causes and identifies areas for improvement.
• Follow up with clinics, patients and/or third party payers to correct errors, obtain missing information, verify referral authorizations, and appeal denied payments.
• Recommends process changes which would resolve re-occurring billing problems, streamline the billing process, decrease the number of retrospective authorizations, enhance patient satisfaction, and maximize cash flow to the clinics.
• Answers billing inquiries from physicians and staff.
• Maintains cooperative working relationships with all customers (including patients and outside contacts) and responds to requests for information in a prompt and courteous manner.
• Communicates with physician and other clinical staff to share guidelines of billing regulations, to ensure compliance and maximum reimbursement of services.
• Performs routine administrative work such as charge entry, handling forms, posting payments & remits, filing, photocopying, faxing, mailing, etc.
• Conforms to hospital standards of performance and conduct, including those pertaining to patient rights, so that the best possible customer service and patient care may be provided.
• Utilizes hospital’s behavioral standards as the basis for decision making and to facilitate the department and the hospital’s goals and mission.
• Follows established hospital infection control and safety procedures. Performs other duties as required.

JOB REQUIREMENTS

• Ability to read documentation; to follow detailed procedures; to perform mathematical calculations; and to communicate effectively orally and in writing; at a level generally acquired through completion of a high school education.
• Requires knowledge of CPT-4 and ICD-9 medical coding and familiarity with referral authorizations and third party billing procedures.
• Knowledge health care billing and collection process including federal and state collection laws, legal collection practices and collection techniques at a level generally acquired through 2 to 3 years on-the-job training or experience in billing Medicare, Medicaid, Blue Cross, HMO, and Commercial insurance collection in a healthcare environment.
• Ability to pay close attention to details and concentrate for up to seventy-five percent of work day resolving some problems independently within department’s operating procedures.
• Demonstrated technical competency using hospital computer systems such as Microsoft Office, Epic EMR and Microsoft Excel proficiency required.
• Medical billing and or Medical Coding .

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE : This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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